There a number of known medical simulation systems that are directed to particular training aspects. One such system is provided by Medical Education Technologies Inc.'s (METI, Sarasota, Fla.) known as HPS, directed to high level anesthesia and critical care training system. However, this system lacks portability and stand-alone capabilities. In addition, the HPS system does not realistically model trauma except as cardiopulmonary sequelae of hypovolemic states. The METI ECS is semi-portable, and the SAPS is a portable, instructor-initiated model-driven control environment that can be programmed to respond according to pre-programmed algorithms or can be manually overridden.
Also known in the art is a system provided by Laerdal Medical AS (Stavanger, Norway) including mannequin systems for first responder basic first aid resuscitation and Advanced Cardiac Life Support training. These systems lack accurate realism and require line-of-sight and an instructor to operate them. Laerdal also offers a base model (Tuff Terry) consisting of a rigid plastic human form that has no treatment responses to be used for modeling patient transport and extraction. Gaumard Scientific Company, Inc. (Miami, Fla.) produces HAL S3000, a mobile, instructor-driven model-based system that can be used for anesthesia and life support training in first responder and in-hospital training, however, it also requires line-of-site instructor operation and is not capable of use in harsh environmental conditions.
In the civilian world, many technical and medical specialties care for trauma victims, including Emergency Medical Technicians (EMTs), paramedics, police officers, fire and rescue teams, HAZMAT teams, nurses, surgeons, and emergency physicians. Homeland Security personnel, including those involved with mass casualty training, CBRNE event scenarios, community disaster teams and other emergency first responders must also be trained in emergency management and mass casualty skills. Training these specialists typically involves some interaction with a simulator. The civilian sector relies on training that includes a combination of simulated patients and real cases to provide the breadth of experience needed to be competent in providing medical care.
Medical simulation systems can be found in situations ranging from total team training, to individual procedure simulators, to basic skills development simulators. A system which encourages medic responsibility and allows for transfer-of-care enables a higher level of total team training. Recertification and reevaluation occur throughout the practitioner's career at regular intervals to ensure the care provided is based on up-to-date standards, and oftentimes to refresh skills.
It is believed that the three leading causes of preventable battlefield death are extremity hemorrhage, tension pneumothorax and airway complications. The leading causes of death because of combat wounds are:                Penetrating trauma: 31%        Uncorrectable chest trauma: 25%        Potentially correctable torso trauma: 10%        Exsanguination from extremity wounds: 9%        Mutilating blast trauma: 7%        Tension pneumothorax: 5%        Airway complications: 1%Improvements in the training of the soldier medic could improve the killed in action (KIA) rates by 15-20%. Suggested critical tasks for medics to learn to higher proficiency include:        Conducting a rapid patient primary survey (Airway, Breathing, Circulation);        Inserting a nasopharyngeal airway and placing the casualty in the recovery position;        Treating life threatening chest injuries with occlusive dressings and being able to perform a needle decompression; and,        Controlling external hemorrhage.        
Another recent development within the Army is the advent of the CLS (Combat Life Saver) program. The CLS course was established to provide for immediate, far-forward medical care on a widely dispersed battlefield while awaiting further medical treatment and evacuation. The proponent for the CLS course, the US Army Medical Department Center and School (AMEDDC&S), recently updated the CLS course to include skills that were recommended from lessons learned in Operations Iraqi Freedom and Enduring Freedom. These revisions include instruction in:                Decision-making skills for treating a casualty when under fire, when not under fire, and during casualty evacuation (tactical combat casualty care or TC3).        Use of the emergency trauma dressing (ETD; a.k.a. Israeli Bandage), an improvement from the old field dressing. The ETD contains elastic ties that ensure the ability to create a functional pressure dressing.        Use of the combat-application tourniquet (CAT), an improvement from the cravat-and-stick tourniquet. The CAT has self-contained components and can be applied with one hand.        Insertion of the nasal airway for treating a casualty with facial injuries or profound levels of unconsciousness.        Use of a large-bore needle to relieve air from a casualty's chest cavity when a chest wound, with collapsed lung, causes cardiovascular compromise (a tension pneumothorax).        Employment of the SKED litter, a kind of rigid plastic wrap-around litter that can be carried or dragged.        